Publications

Interview, self-report, peer-report, and observational data were used to examine parent and peer relationship qualities as predictors of relative changes in attachment security in a community sample of adolescents followed from age 14 to 24. Early maternal supportive behavior predicted relative increases in attachment security from adolescence to adulthood, whereas psychological control and interparental hostile conflict predicted relative decreases. Peer predictors of relative increases in security included collaborative and autonomous behaviors and lack of hostile interactions, with peer predictions growing stronger for relationships assessed at later ages. Overall, models accounted for sufficient variance as to suggest that attachment security across this period is well explained by a combination of stability plus theoretically predicted change linked to social relationship qualities.

Struggles managing conflict and hostility in adolescent social relationships were examined as long-term predictors of immune-mediated inflammation in adulthood that has been linked to long-term health outcomes. Circulating levels of interleukin-6 (IL-6), a marker of immune system dysfunction when chronically elevated, were assessed at age 28 in a community sample of 127 individuals followed via multiple methods and reporters from ages 13 to 28. Adult serum IL-6 levels were predicted across periods as long as 15 years by adolescents’ inability to defuse peer aggression and poor peer-rated conflict resolution skills, and by independently observed romantic partner hostility in late adolescence. Adult relationship difficulties also predicted higher IL-6 levels but did not mediate predictions from adolescent-era conflict struggles. Predictions were also not mediated by adult trait hostility or aggressive behavior, suggesting the unique role of struggles with conflict and hostility from others during adolescence. The implications for understanding the import of adolescent peer relationships for life span physical health outcomes are considered.

Adolescent romantic relationships have the potential to affect psychological functioning well into adulthood. This study assessed adolescent romantic relationship qualities as long-term predictors of psychological functioning utilizing a longitudinal multi-method, multi-informant study of 80 participants (59% female; 54% Caucasian, 35% African American, 11% mixed or other race) assessed at age 17 along with their romantic partners and at ages 25–27. Controlling for gender, family income, and baseline mental health, partner-reported hostile conflict at age 17 predicted relative increases in internalizing behaviors from age 17 to 27. In contrast, observed teen support with their partner during a help-seeking task at age 17 predicted relative decreases in externalizing behaviors over time. The results are interpreted as suggesting qualities that may help determine whether adolescent romances have positive vs. negative long-term psychological health implications.

This study assessed the key aspects of romantic relationship dissolution in emerging adulthood as predictors of future mental health and romantic qualities. It utilized a longitudinal, multiinformant, multimethod study of 160 participants with their romantic partners and close friends followed from ages 20–25, with a breakup assessed at age 22. Having control over initiating a breakup at age 22 predicted relative increases in peer-rated internalizing symptoms and autonomy-undermining interactions with a new partner at ages 23–25. Having a greater understanding of the reasons for a breakup predicted lower self-reported internalizing symptoms and relative decreases in partner-reported romantic conflict as well as relative increases in selfreported relationship satisfaction and peer-rated intimate relationship competence at ages 23–25. Predictions remained after accounting for numerous potential confounds including age 20–22 baseline relationship quality, social competence, internalizing symptoms, and gender. Implications for understanding links between breakup characteristics on emerging adult psychological and relationship functioning are discussed.

Adolescents’ negative expectations of their peers were examined as predictors of their future selection of hostile partners, in a community sample of 184 adolescents followed from ages 13 to 24. Utilizing observational data, close friend- and self-reports, adolescents with more negative expectations at age 13 were found to be more likely to form relationships with observably hostile romantic partners and friends with hostile attitudes by age 18 even after accounting for baseline levels of friend hostile attitudes at age 13 and adolescents’ own hostile behavior and attitudes. Furthermore, the presence of friends with hostile attitudes at age 18 in turn predicted higher levels of adult friend hostile attitudes at age 24. Results suggest the presence of a considerable degree of continuity from negative expectations to hostile partnerships from adolescence well into adulthood.

Results of an RCT examining the effects of a brief psychosocial intervention on inpatient satisfaction

Background and Objectives

Increasing attention is being paid to patients’ experience of hospitalization. The brief psychosocial intervention, BATHE, is an intervention found to improve patients’ outpatient experience but not yet studied in inpatient settings. This RCT examined whether daily administration of BATHE would improve patients’ satisfaction with their hospital experience.

Methods

BATHE is a brief psychosocial intervention designed to reduce distress and strengthen the physician-patient relationship. In February-March 2015 and February-March 2016, 25 patients admitted to the University of Virginia Family Medicine inpatient service were randomized to usual care or to the BATHE intervention. Participants completed a baseline measure of satisfaction at enrollment. Those in the intervention group received the BATHE intervention daily for five days or until discharge. At completion, participants completed a patient satisfaction measure.

Results

Daily administration of BATHE had strong effects on patients’ likelihood of endorsing their medical care as “excellent.” BATHE did not improve satisfaction by making patients feel more respected, informed or attended to. Rather, effects on satisfaction were mediated by patients’ perception that their physician showed “a genuine interest in me as a person.”

Conclusions

Our study suggests that patients are more satisfied with their hospitalization experience when physicians take a daily moment to check in with the patient “as a person” and not just as a medical patient. The brevity of the BATHE intervention indicates that this check-in need not be lengthy or overly burdensome for the already busy inpatient physician.

Keywords: hospitalization, patient satisfaction, physician patient relationship

Secondary school is a vulnerable time where stagnation or declines in classroom behavioral engagement occur for many students, and peer relationships take on a heightened significance. We examined the implications of adolescents’ perceptions of relatedness with classroom peers for their academic learning. Participants were 1084 adolescents (53% female) in 65 middle and high school classrooms. Multilevel cross-lagged path analyses found that adolescents’ perceived relatedness with classroom peers subsequently predicted their increased self-reported behavioral engagement in that classroom from fall to winter and again from winter to spring. Higher engagement in spring predicted higher end of year objective achievement test scores after statistical control of prior year test scores. Implications are discussed for increasing classroom peer relatedness to enhance adolescents’ achievement.

Adolescents face the developmental challenge to establish a sense of identity and autonomy while at the same time remaining connected to and engaged with their family—the original source of safety. Not only do teens strive to establish a healthy balance with their families, but they also are learning to navigate more autonomous relationships with peers, and later with romantic partners. Failure to form healthy close relationships in adolescence has been linked to poor psychological, social, and physical health into adulthood, highlighting the importance of these early relationships. We review the extensive research on adolescent autonomy from our longitudinal study of adolescent development. Overall, research on parental influence on adolescent development is largely informed by research on the mother–child relationship. Less research has considered the unique role that fathers may play in adolescent development. We will report on new research findings that father–child relationships with high levels of both autonomy and relatedness are linked to better quality of teen romantic relationships, both concurrently and longitudinally. This recent work is discussed and future directions proposed to consider the distinct role of fathers for the developmental task of establishing autonomy yet remaining connected to others in adolescence.